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HIV-ITP and initial regime
Jan 3, 2004

Back on Nov 4th, I posted a question about HIV-ITP and asked what my options were in terms of initiating treatment. An update: my last 6 platelets counts were as follows: 97, 78, 63, 82, 64 (two weeks ago), and 70 (this is last Friday's count). Both the hematologist and my infections disease specialist have said I can wait to initiate either HAART, or perhaps prednisone when, and if, my count falls below 50. Three questions for you: 1) does this indicate a plateau in terms of platelet count; 2)does the idea that this is just a "cycle" that needs to be broken; in other words, maybe a short term stint on prednisone may break the cycle and when we taper the platelet count will not decline once more, and: 3) if I were to start HAART, I was looking at the Combivir + Sustive combo, but have been reading that AZT suppresses the bone marrow (where platelets are produced, so I was thinking Sustiva + Epivir + tenofovir. What do you think of that combo as an intial treatment regimen? Thanks for your time.

Response from Dr. Pierone

Hello, I agree that the low platelets from ITP (idiopathic thrombocytopenic purpura) do not need to be treated unless they drop below 50 thousand. It does look like a plateau in your platelet count. I don't think that treatment with prednisone will necessarily break a cycle of ITP. With regard to HAART, either regimen would be expected to improve the platelet count. AZT does not really have much impact on platelets so I would not shy away from it based on this issue (the real issue with ITP is inappropriate destruction of platelets anyway). The Sustiva, Epivir, Tenofovir regimen is somewhat easier since it can be taken once daily. Good luck!

scary thought. what is really the deal?
rise in VL and hep A-B vaccine

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